PURPOSE: Axillary nerve injury is a common nerve palsy that affects shoulder abduction and forward flexion, while also contributing to neuropathic pain and numbness. A complete axillary nerve injury can be reconstructed via nerve repair, grafting, and/or end-to-end nerve transfers; however, in the setting of incomplete nerve injuries QS decompression with or without supercharge end-to-side transfers (SETS) may help by neurolysis and bringing additional axons closer to motor end plates respectively. This study aims to investigate the role of nerve surgery in the management of incomplete axillary nerve injury by describing a series of patients who demonstrated minimal improvement with non-operative management and were treated with surgical decompression at the QS with or without nerve transfer. We hypothesize that patients with incomplete axillary nerve injury will benefit from surgical intervention.
METHODS: A retrospective chart review of patients with incomplete axillary nerve injury who received QS decompression with or without selective medial triceps to axillary (anterior, posterior, or both axillary nerve branches) between January 2020 and July 2024 at the Ohio State University Wexner Medical Center was conducted. Primary outcome variables included British Medical Research Council (MRC) muscle scale for shoulder abduction score and affected shoulder pain measured on a visual analog scale (VAS). Baseline demographic, injury, and surgical-related variables were also collected.
RESULTS: A total of 18 patients underwent nerve surgery at a mean of 12.7 months after injury. Fifteen (83.3%) patients achieved an MRC grade shoulder abduction score of 3 or greater after intervention, compared with only 8 patients (44.4%) patients pre-operatively. There was a significant difference between mean pre-operative shoulder MRC scores of 2.8 ±1.4 compared to post-operative MRC scores 4.1 ±0.86 (p <0.001). There was a significant decrease between pre-operative VAS shoulder pain scores of 6.0 ± 2.8 and post-operative VAS scores of 2.5 ± 1.94 (p <0.001).
CONCLUSION: QS decompression with or without SETS nerve transfer is associated with an improvement in shoulder abduction and pain. Patients with incomplete axillary nerve recovery after injury may benefit from QS decompression and potentially a SETS nerve transfer to maximize functional recovery.